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After years of obsessing about it, weighing all my options, and talking to doctors and even med school friends, I finally took the plunge and got an Intrauterine Device (IUD). I was excited and terrified at the same time. If you’re wondering why an unmarried 23 year-old is obsessed with getting an IUD, we’ll talk about me, tokophobia, and childfreedom next time.

“The IUD is a little, t-shaped piece of plastic that gets put in your uterus to mess with the way sperm can move and prevent them from fertilizing an egg. Sounds odd, but it works like a charm. IUDs offer years of protection—between three and twelve, depending on the type you get. And if you want to get pregnant, you can have the IUD removed at any time.” – Bedsider.org

The biggest draw for me was that IUDs are in the 99+ % range of effectiveness. You’d hear some stories of them failing, sure, but you have to remember that they are in the very small minority and this is as close to 100% as you can get without a tubal ligation. My previous two OB-GYNEs did not think an IUD was a good idea for me, and I only found the right doctor through a friend who got hers there too. There are several reasons why an OB-GYNE might decline from giving you an IUD.

“So what are these common reasons?”

  1. You’re too young, and for some conservative doctors, unmarried
  2. You haven’t had children yet
    1. Insertion is apparently more painful if you haven’t been, shall we say, stretched out
    2. It’s allegedly more likely to fall out
  3. Your behavior does not put you at such a risk that you’ll need a 99+ % method
  4. You have Pelvic Inflammatory Disease or other infections, or are prone to them
  5. You have an STD, i.e. gonorrhea or chlamydia

If you ask me, reasons 4 and 5 are the only ones that should truly be considered. Reason 1 is more imposition of values than anything else, reason 2 is debatable, and reason 3 is silly because there is no such thing as too effective. I got told reasons 1 through 3, by the way.

“What’s the procedure for getting an IUD?”

  1. You need to get a pap smear at least a month beforehand. An IUD does not cause infections, but it will aggravate an infection if you already have one. That’s why the pre-procedure pap smear is very important. The doctor will be able to give you the necessary antibiotics to clear up any issues you’re having.
  2. You choose between the two types of IUDs: hormonal and non-hormonal (copper).
    1. Hormonal IUDs — the more common one is Mirena, which is good for 5 years. I’m not sure if the new one, Skyla, is already available in the country. Skyla is good for 3 years and is specifically geared towards younger women who haven’t had children yet. It works like the BC pill but better because there’s no room for human error such as forgetting to take a pill. Your periods may stop altogether, by the way.
    2. Non-hormonal or copper IUDs — ParaGard, good for 12 years. It (1) releases copper into the uterus which works as a spermicide and (2) changes the lining of the womb, making it less suitable for a pregnancy. This is the one I have. It can make your periods heavier than they were before.
  3. If you are cleared by your OB-GYNE to get an IUD, and you’ve already decided on which one, you can set up an appointment. According to my doctor, it should be done during the proliferative phase of the menstrual cycle (the phase after menstruation). It could also be done as emergency contraception if you had unprotected intercourse in the last 120 hours.
  4. There are drugs you have to buy before your procedure. This may vary, but for me it was:
    1. Doxycycline 100 mg (twice a day for 7 days, beginning on the night before the procedure)
    2. Mefenamic Acid 500 mg (2 tablets an hour before the procedure, every 8 or so hours afterwards)
  5. You have to sign a consent form which states that the procedure might be painful and that you’re okay with that.
  6. The procedure itself will take around ten minutes.
    1. The OB-GYNE will talk to you about your life choices, what the process is going to be like, and how to maintain your IUD.
    2. S/he will conduct the initial Trans-vaginal Ultrasound (TVS) to check the size and shape of your uterus.
    3. Like during a pap smear, s/he will insert the cold metal speculum.
    4. S/he will measure your uterus. This is the part that hurts the most.
    5. S/he might dilate your cervix. This was uncomfortable but not really painful.
    6. S/he will trim the IUD’s strings to the correct size, then insert it. This also hurts, but not as much as the measuring part.
    7. S/he will do another TVS, this is the one you will get a printout of, showing the little T that is your new IUD.
  7. Afterwards, I advise that you wear a sanitary pad for any discharge. And you will probably have to wear pantyliners for the next couple of weeks because as the body adapts to the IUD, discharge will be continuous.
  8. The next 24 hours will be hell. The level of pain depends on your tolerance of course, but I haven’t met anyone who said they weren’t in pain for those 24 hours. It’s like the worst dysmenorrhea of your life multiplied by ten. I took a lot of mefenamic acid, slept a lot, and used a hot water bottle whenever I felt fine enough to stand up.
  9. After your first period, you’ll probably completely forget that it’s there.
  10. You need to get another TVS sometime after your first period to check on its position. After that, you just need your annual OB-GYNE visit, pap smear, and TVS.

“So how much did this entire thing cost?”

The procedure cost 2300 PHP, the medicines were another 200 PHP. The upcoming TVS is about 600 PHP. All in all you should prepare something like 3500 PHP for the entire adventure, including your taxi ride home from the clinic. Do not commute, I repeat, do not commute home. Get in a taxi and get yourself to bed as soon as possible. Your body will make you take the rest of the day off. If you live alone, you should also prepare food and drinks beforehand so you won’t have to go out.

“What happens if I still get pregnant?”

Yes it can happen, but rarely. This is why it’s nice to always, always have a backup method. Spermicides, condoms, the BC pill if you’re using a copper IUD like me, or withdrawal will all make your chances of getting pregnant lower.

In the event that you do fall pregnant, you also have to understand that an IUD raises your risk of having a miscarriage to 40 – 50%. It also raises the risk of having an ectopic pregnancy, in which case the pregnancy must be terminated. If you become pregnant, your OB-GYNE will recommend the removal of the IUD, which may also result in a miscarriage. That said, I’ve read stories of women carrying to term successfully even with the IUD left inside, so it’s really a case to case basis.

“How do you feel about your copper IUD?”

ParaGard has been great and hasn’t given me any problems since the hellish 24 hours post-procedure. I occasionally got strange crampy feelings down my left side or bottom abdomen during the first month, but the frequency lessened and lessened with time. I’ll update when I get another TVS this week.

IUD Removal

You can have it removed at anytime, and that procedure costs a lot less!

Additional Reading